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The experience use of drug-coated & non drug-coated balloons in arteriovenous fistula at a six months period: brief report
Alireza Rai, Siros Amiri, Mohammadreza Sobhiyeh,
Volume 78, Issue 4 (7-2020)
Abstract
Background: The ineffectiveness of hemodialysis fistulas causes high costs and increases mortality and morbidity rates. The efficacy of drug-coated balloon and nondrug-coated balloon in dysfunctional arteriovenous Fistula was evaluated over six month period.
Methods: In this randomized clinical trial, a total of a total of 50 hemodialysis patients who referred to Imam Reza Hospital in Kermanshah for failing of arteriovenous fistula in 2018 year, were randomly divided into two separate groups of drug-coated balloon angioplasty and non-drug coated balloon angioplasty. All of these procedures were done with the same surgeon. Patients were followed-up for 6 months. Variables and data of patients like age, gender, diabetes mellitus, hypertension, and location of arteriovenous fistula were documented and analyzed by SPSS software, version 21 (SPSS Inc., Chicago, IL, USA) using statistical tests. T-test and chi-square test were used for data analysis and the significance level was considered less than 0.05.
Results: The success rate of drug-coated balloon angioplasty versus plain balloon angioplasty in the efficacy of arteriovenous fistulas increased significantly (19 vs. 6 and 13 vs. 12, respectively, P<0.05). There is also a significant relationship between age and diabetes over the lifetime of the arteriovenous fistula. According to results, the efficacy of arteriovenous fistula in the elderly patients (>65 years) and the diabetes mellitus patients were lower than other risk factors causing end-stage renal disease.
Conclusion: According to the results of this study, the use of drug-coated balloons rather than non drug-coated balloon is more effective in the efficiency of arteriovenous artery fistula.

The role of MMP9 C-1562T and MMP2 G1575A genetic variants in male infertility: review article
Rezvan Asgari, Mitra Bakhtiari,
Volume 78, Issue 6 (9-2020)
Abstract
Infertility as a vital process in human reproduction involves many couples worldwide. Although many genetic causes of infertility are known, the genetic basis of infertility in men is largely unknown. Therefore, the identification of genetic biomarkers in this field is important and genetic polymorphisms in key genes of the spermatogenesis pathway can be valuable biomarkers in this field. Gene's polymorphisms with specific genetic background and/or environmental factors can lead to the dysfunction in testicular function or the process of sperm production. Matrix metalloproteinases (MMPs) are a family of zinc-dependent enzymes that play an important role in extracellular matrix remodeling by activating gelatinases, collagenases, and proteolytic enzymes. These enzymes are essential for the regulation of cellular connections in the testis. Extracellular matrix degradation and connective tissue remodeling are important structural changes in germ cell migration that are controlled through important genes, including MMPs and their biological inhibitors. Given the important role of MMPs in the structural and functional characteristics of reproductive organs, genetic polymorphisms in MMP genes are significant because they can influence gene transcription and the biological function of proteins. Studies have shown that matrix metalloproteinases are involved in the degradation of extracellular matrix and play an important role in the process of spermatogenesis and sperm quality. This review article aims to evaluate the role of two common, functional MMP2 G1575A and MMP9 C-1562T polymorphisms in male infertility. The findings indicate that polymorphisms of MMP2 G1575A and MMP9 C-1562T can affect gene transcription, protein level, and enzymatic activity, and also, these variants can be as one of the genetic causes in male infertility among different ethnic populations. Therefore, identifying these molecular changes can help to adopt appropriates therapeutic and diagnostic measures as well as guide therapeutic approaches to intelligent therapies. To achieve a definitive conclusion and confirm the association of these polymorphisms with male infertility, evaluations of gene-gene and gene-environment interactions can be important for larger sample sizes of different ethnicities.
The prevalence of respiratory allergens in patients with asthma and allergic rhinitis in Ardabil province
Rasool Molatefi, Adel Ahadi, Hossein Salehzadeh, Elham Safarzadeh, Hadi Abbasi,
Volume 78, Issue 8 (11-2020)
Abstract
Background: Because of geographic variation and regional types of allergens, it is recommended that allergists identify common allergens in their area of activity. In the present study, the prevalence of respiratory allergens in patients with asthma and allergic rhinitis was investigated.
Methods: This study is descriptive and retrospective. The required data of this study were extracted from the records of 661 patients who were referred to the Asthma and Allergy Clinic of Ardabil University of Medical Sciences (Ardabil province, Northwest of Iran) from April 2016 to March 2017. After confirmation of allergic asthma or rhinitis by the asthma and allergy specialist, these patients were subjected to a prick test with allergen extracts. In the group of grasses the extract of nine grasses, in trees the extract of 11 Tree mix, in weeds the extract of Common weed mix, in animal allergens the three extracts of Standard cat, Dog epithelia, Cockroach mix, in weeds the Mite mix and in fungi, three extracts of Mold mix1, Alternaria and Aspergillus mix were used. All the data were analyzed using SPSS software, version 25.
Results: According to results, of the 661 patients who were studied, 462 ones had positive and 273 had significant prick test results. The grasses group with 293 positive (44.3%) and weeds group with 259 positive results (39.2%) were more common than the other categories. Among the significant positive tests, these two categories with 161 and 142 significant positive tests were indicated as the most common allergens. Respiratory allergens were also more common in patients with a family history of allergies in weeds and trees categories, but there was no significant difference in sensitization pattern according to the history of tonsillectomy.
Conclusion: Patients in Ardabil with allergic rhinitis and asthma were more sensitized to weeds and grass mixtures. It is recommended to provide preventive recommendations to allergic patients and the development of localized skin testing packages and additional studies should be conducted focusing on these two categories of allergens.

Equity of hospital bed distribution in Tehran city: brief report
Ali Mohammad Mosadeghrad, Hamed Dehnavi, Alireza Darrudi,
Volume 79, Issue 2 (5-2021)
Abstract
Background: Health equity is “having fair access to healthcare, utilizing it according to actual needs, paying for it based on financial capacity and finally, having an acceptable level of health”. Health equity is an underlying principle of the universal declaration of human rights. Equitable distribution of hospital beds increases people’s access to healthcare services and as a result, improves their health status. This study aimed to examine the equity in the geographic distribution of hospital beds in Tehran city, Iran.
Methods: The data for this descriptive and cross-sectional study were obtained from the Ministry of Health and the Iranian statistics center in April 2019. All hospitals in Tehran city were included in this study. Lorenz curve and the Gini coefficient were used to measure the equity in the geographic distribution of hospital beds. Excel software was used for data analysis.
Results: Tehran city had a population of 8,693,706, and 142 hospitals with 24,535 beds in 2016. There was 1.6 hospitals per 100,000 people and 2.8 hospital beds per 1000 people in this city. Nearly half of the hospitals were private (49%) and the remaining were public or semi-public. About 77% and 23% of hospitals were general and specialized respectively. Almost half of the hospitals are more than 40 years old.  The average number of beds in hospitals was 173. The Gini coefficient was 0.619 for hospital bed distribution among Tehran districts. Districts 6, 12 and 3 have had the highest hospital beds per 1000 people. Districts 6 had 23% of the total hospitals and 24% of the hospital beds.
Conclusion: The geographic distribution of hospital beds in Tehran city is not equitable. Hospital services should be accessible based on actual need rather than on the ability to pay. Achieving health equity is a prerequisite of universal health coverage. Hence, healthcare policymakers should reduce or eliminate the existing disparities and inequalities in access to hospital beds.

The effect of hip joint position on knee joint isokinetic dynamometry indices in football and track and field athletes
Mandana Rezaei, Nader Sadri-Aghdam , Mahmood Reza Azghani, Fariba Ghaderi, Hakimeh Adigozali,
Volume 80, Issue 8 (11-2022)
Abstract
Background: Isokinetic dynamometry is a golden standard test to estimate lower extremity sport related injuries in the athlete assessment. Dynamometry is also commonly used to design preventive protocols. The aim of this study was to explore the effects of hip joint positioning in seated and lying positions on knee joint dynamometry indices, including extensor and flexor peak torques in football and track and field athletes.
Methods: Forty four male athletes (including 22 football players and 22 track and field athletes) have participated in this descriptive-analytic study. The sampling method was simple nonrandom sampling. This study was conducted in the Biomechanics laboratory of the Rehabilitation Sciences, Faculty of Tabriz University of Medical Sciences since October 2019 to October 2020. Knee joint dynamometry indices were consisted of concentric and eccentric flexor and extensor peak torques at 60 degrees per second velocity. Optimum length, angle of crossover, and the muscle balance ratios (concentric extensor peak torque/concentric flexor peak torque and eccentric extensor peak torque/concentric flexor peak torque) were also evaluated. All assessments were performed in both seated and lying positions. The indices were compared between football players and track and field athletes.
Results: The interaction effect of group and hip joint was not significant (P<0.05). Further, concentric and eccentric flexor and extensor peak torques and conventional flexor to extensor ratio were higher meaningfully in the seated position compared to the lying (P<0.05). Optimum length was significantly higher in the lying position, but the angle of crossover was higher in the seated position (P<0.05). The hip joint position was not effective on the functional flexor to extensor ratio (P>0.05). Also, dynamometry indices were not different between football and track and field groups (P<0.05).
Conclusion: Findings revealed the effects of hip joint position on strength measurements in football and track and field athletes. This factor should be considered to design strengthening exercises for athletes and also to estimate the sport injury risk.

Experiences of countries in recruiting and retaining physicians in deprived areas: a systematic review
Zahra Asadi-Piri , Ebrahim Jaafaripooyan,
Volume 80, Issue 11 (2-2023)
Abstract
Background: Access to healthcare is a fundamental right of every individual, regardless of their geographic location or socioeconomic status. In many countries, deprived areas often face a shortage of physicians and other healthcare professionals. This study aimed to investigate the approaches essential to attract and retain physicians in the deprived and rural areas.
Methods: The present study is a systematic review using appropriate keywords in Persian and English language. The main databases including Google Scholar, Scopus, Web of Science, PubMed, SID, and IranMedex were searched from May 2005 to September 2022 in both languages. Different approaches implemented by countries to attract and retain doctors were classified using thematic analysis.
Results: A total of 18 articles were selected for inclusion in the study. Educational, regulatory, motivational, and personal and professional support drivers have been used to attract and retain physicians. The successful interventions implemented were mainly educational and supportive; such as admitting native medical students, providing relevant curricula on working in the deprived and rural areas, and conducting training courses in these regions. Those studying the topics and courses related to serving in the rural areas during their academic education or internship and residency programs had served more time in these areas. Assimilating the topics related to providing services in rural areas into the curriculum, holding fellowship courses and related graduate studies, awarding scholarships to the physicians working in deprived areas, providing free amenities, reducing working hours, and considering special holidays are considered among the recommended solutions.
Conclusion: Various drivers were used for attracting and retaining physicians in the deprived and rural areas. Besides, the challenge to retain doctors in such areas was fairly common. Most countries have put more priority on the use of financial incentives, nevertheless, a combination of interventions was preferred. It is worth mentioning that a range of economic, political, and social factors could play a key role in the success of recommended interventions.

Efficacy of treatment in children and adolescents with vasovagal syncope in the long term: an 8-year follow-up study
Mohammad Reza Sabri, Bahar Dehghan, Mahsa Rafiee Alhossaini ,
Volume 81, Issue 1 (4-2023)
Abstract
Background: Syncope is a temporary loss of consciousness with a loss of postural tone. Medicinal treatment of reflex syncope has shown to have no significant effect in reducing the recurrence of syncope. A 36-month follow-up of our pilot cohort showed that non-pharmacological treatments alone were effective in reducing relapse rates. The purpose of this study is to investigate long-term results and 8-year follow-up of previous patients.
Methods: The current study is a continuation of a prospective pilot cohort which was done between August 2013 and 2014 in two academic hospitals in Isfahan (Dr. Chamran heart center and Imam Hossein children hospitals). This current study examines the 8-year follow-up results of children with reflex syncope who were treated with non-pharmacological treatments alone or with drugs. Therefore, the patients who participated in the pilot study were enrolled (30 patients in the pharmacologic group and 40 patients non-pharmacological group). Finally, on 26 patients in the pharmacologic group and 31 patients in the non-pharmacological group (after applying the exclusion criteria), the incidence of syncope and pre-syncope attacks was compared between these two groups of patients using the Chi-square test.
Results: Our study showed that within 5 years after the last follow-up, the incidence of syncope and pre-syncope in patients with a history of vasovagal syncope who did not continue the diet or tilt exercises was different between the two groups of patients (without medication and drug recipient) was not significantly different, even the incidence of presyncope increased significantly again in both groups. The incidence of syncope in the period of 5 years after the last follow-up from the previous study was slightly increased in the group of patients without medication compared to the previous periods, but in the group of patients receiving medication, this incidence decreased slightly.
Conclusion: In order to prevent recurrence, the use of non-pharmacological methods is effective, but for the stability of this recovery, follow-up and continuation of these methods is necessary.

Investigating the effect of surgery time on improving the performance of fine movements of lower limbs in patients with traumatic spinal cord injury
Loghman Barani, Hossein Jafari Marandi , Masoud Zeinali, Hossein Safari,
Volume 81, Issue 2 (5-2023)
Abstract
Background: Traumatic Spinal Cord Injury (TSCI) is one of the catastrophic events, the rate of which has been growing compared to the past decades. Complications caused by TSCI have a wide spectrum and can range from complete paralysis to numbness of the limbs. Additional to the injury severity and disability of the patient, the recovery rate depends on the treatment strategies. Despite extensive efforts and research in this field, there are still few treatment options for TSCI patients. Controversial results have been reported, however, spinal cord decompression is the only certainty for the treatment of these patients. In the present study, patients with thoracic and lumbar fractures were undergone decompression, less and more than 24 hours, and the recovery rate (RR) was compared after 6 months.
Methods: In this study, patients with lumbar and thoracic fractures who were referred to the neurosurgery department of Ahvaz Golestan Hospital during May 2019 to December 2021 were included. Decompression was performed at the fracture level as a total and at the upper and lower levels of the fracture as a partial decompression. To evaluate fine motor movements, picking up a small object with toes and following a rectangular path were used. Also, the gross motor movements, upper and lower proximal and distal muscle forces were measured.
Results: 160 patients including 133 men (83.1%) and 16.9% women (27) with 36±12 years mean age were included. The most fracture location was lumbar (53.1%), followed by the thoracic (43.1%) and fractures in both regions (3.8%). The most injured  vertebras were L1 (27.5%) and T12 (18.8%). Six months later, 61.9% of patients had a good score for removing a small object with toe, of which 67.5% belonged to patients with<24 hours surgery (P=0.01). Also, RR for ability to follow a rectangle (P=0.017) and lower limit gross motor were significantly better in patients with<24 surgery (P=0.02). However, no significant difference was found between the two groups for improved sensations (P<0.05).
Conclusion: This study showed that decompression<24 hours in TSCI is associated with a significant improvement in lower fine movements.
 
Comparison of magnetic resonance imaging and CT scan in patients with complaints of mediastinal and chest wall mass
Mahdi Yadollahzadeh, Nader Rezaei , Mohsen Farrokhpour , Mehdi Azimi, Maedeh Barahman, Mohammad Bahadoram , Amirhossein Forouzanmehr , Seyed Ali Javad Mousavi ,
Volume 81, Issue 6 (9-2023)
Abstract
Background: The realm of diagnosing intrathoracic lesions involves a spectrum of imaging methodologies, among which computed tomography (CT)-scan and magnetic resonance imaging (MRI) stand prominent. In the context of Iran, where there is no study comparing the efficacy of CT-scan and MRI for evaluating intrathoracic lesions, our study endeavors to bridge this gap. Mindful of the nuanced advantages and drawbacks inherent in each method, we aim to conduct a comprehensive comparative analysis of CT-scan and MRI in diagnosing intrathoracic lesions, focusing on patients seeking care at Firoozgar Hospital's pulmonary clinic.
Methods: Embarking on a cross-sectional exploration at Firoozgar Hospital Pulmonary Clinic in Tehran, Iran, our investigative journey unfolded between April 2020 and March 2021. Thirty patients, spanning ages 21 to 69, presenting with intra-thoracic lesions encompassing mediastinal and chest wall anomalies, underwent simultaneous CT scan and MRI examinations. In pursuit of diagnostic certainty, histopathology was ordained as the gold standard, and the ensuing results underwent meticulous scrutiny and analysis utilizing SPSS 23 statistical software.
Results: Our study cohort comprised 30 patients, averaging 44.83 years (SD=12.71), with males constituting 60% of the population. Delving into the histological reports, CT-scan and MRI accurately diagnosed 25 (83.3%) and 28 (93.3%) cases, respectively, in retrospective analysis. The Kappa matching coefficient for CT-scan stood at 0.783, while for MRI, it soared to 0.912. A notable revelation surfaced as the Kappa matching coefficient for both CT-scan and MRI maintained a robust 0.783 (P<0.001 in all three cases).
Conclusion: MRI might wield a superior diagnostic prowess compared to CT-scan in evaluating intrathoracic lesions. The robust Kappa matching coefficients endorse a substantial concordance between the two imaging modalities. The implications further beckon contemplation that, in select scenarios, the acquisition of biopsy and histopathology may prove redundant when scrutinizing intrathoracic lesions using the tandem approach of CT-scan and MRI. However, to etch these findings into the annals of medical certainty, a multicenter study endowed with a judicious sample size emerges as an imperative next step.

Existential distress in palliative care of cancer patients at the end of life: a systematic review
Hossein Eskandari, Faramarz Sohrabi , Adeleh Rezagholizadeh Shirvan , Mohammad Asgari , Neda Shahvaroughi Farahani ,
Volume 81, Issue 12 (3-2024)
Abstract
Background: The experience of existential distress, along with other forms of distress, is one of the common experiences in end-of-life patients. Therefore, the purpose of this research is to review related studies and conceptualize existential distress in palliative care of cancer patients.
Methods: This study was a systematic review, which was conducted from May 1 to July 31, 1402 at Allameh Tabatabai University and search strategy was written and performed in MEDLINE, Web of Science/PubMed and Scopus databases from the beginning of 2003 to the end of 2022. The inclusion criteria included all quantitative, qualitative, mixed and review studies that focused on the experience of adult patients. Lack of access to the full text of the article and studies in non-English language, clinical trial (randomized and non-randomized), letter to the editor, case report and protocol were excluded from the list of studies. After removing duplicate articles, two research authors reviewed the studies independently according to the inclusion and exclusion criteria, and the differences between them were resolved by discussion.
Results: After searching, screening and selecting articles based on inclusion and exclusion criteria, finally 22 articles were included in the study, of which three were review articles, eight were quantitative and 11 were qualitative. Terminally cancer patients experience existential distress, and the data are significant for estimating the prevalence of these symptoms, especially in the severe category. In addition to examining the prevalence of this symptom, patients have described their experience of existential distress in several categories: Feelings of loneliness and isolation (or loss of support system), relationship concerns (concerns about family, changes in relationships, and conflictual relationships), loss of control/autonomy (physical control, cognitive and emotional control), burden on others, loss of sense of continuity (loss of roles, pleasurable activities and sense of self), uncompleted life tasks, hopelessness/helplessness, dissolving of the future, uncertainty and frightening ambiguity, feeling guilt/ regret about the past, lack of meaning, inevitable thoughts of death.
Conclusion: It seems that the themes raised beyond cultural differences show the universal human suffering, whose accurate conceptualization can help to develop effective therapeutic interventions to reduce existential distress.

Challenges and solutions of integration in the health service delivery: a scoping review
Aida Asghari, Abbas Vosoogh Moghaddam , Ali Mohammad Mosadeghrad , Ebrahim Jaafaripooyan,
Volume 82, Issue 2 (5-2024)
Abstract
Background: Communication and cooperation among health care organizations have become nowadays crucial for improving the quality and equity in providing health services, and integration has been expressed as a solution by the World Health Organization. The purpose of this review was to identify the challenges and solutions of integration in health services.
Methods: This research was carried out from September 2023 to April 2024. All articles on the challenges and solutions of integration in health, using scoping review, were identified and used in the PubMed, Scopus, Web of Science and Google Scholar search engines in the period from 2000 to 2024. The total number of English articles found was 4996, of which 662 were removed due to repetition. Among the remaining 4334 articles, 4249 articles whose titles and abstracts were not related to the research topic were removed, left a total of 85 articles, and after reviewing the full text of the articles, 27 articles entered the data extraction phase, which were finally analyzed using the framework analysis method.
Results: Finally, 27 articles were selected from which, 46 challenges and 26 solutions were extracted as to the integration in health services and categorized based on the framework of WHO six building blocks in five areas of governance and leadership, financing, human resources, information system and service delivery. The most important challenges of integration include; weakness in planning, imbalance of power between organizations, differences in geographical and spatial boundaries of organizations, weakness in maintaining data security, workforce resistance and the lack of laws and regulations, needs assessment from patients, related knowledge, financial resources, suitable payment models, integrated communication and information systems and interoperability between technologies. 
Conclusion: Integration of health service endures a series of challenges such mainly as the lack of rules and regulations for collaborative processes and resistance from providers and employees requiring innovative solutions. Addressing issues such as stakeholder power-benefit analysis, interoperability and data sharing among the providers could be essential for successful integration.

Epidemiological investigation of emergency department visits in patients with cancer: a three-center study
Mohammad Masud Khubiari , Simin Najafgholian, Bahareh Abbasi, Ramin Parvizrad, Reza Aghbozorgi,
Volume 82, Issue 5 (8-2024)
Abstract
Background: Emergency Departments (EDs) visits reflect medical needs and demands or the only care available to patients. Many ED visits are potentially preventable with access to high-quality, community-based health care. Given the higher incidence of emergency conditions in patients with cancer the global increase in cancer will pose a challenge for emergency services. Therefore, this study was conducted with the aim of epidemiological investigation of emergency department visits by cancer patients in several centers.
Methods: In this cross-sectional study, the triage form and hospital file of known patients with various cancers, who visited in Eds of valiasr and Amir al Momenin hospitals in Arak, Hazrat Rasool Akram and Lolagar hospitals in Tehran, and Shahid Sadouqi and Shah vali hospitals in Yazd, From April to September 2017. To measure the urgency of ED visits, the emergency severity index and triage form were used, and the outcome of the emergency visit was extracted from the patient's file and recorded in the data collection checklist. Multivariate logistic regression analysis was used to examine the association of patient, hospital and potentially preventable factors.
Results: In this study, 1107 patients, 550 men (%49.7) and 577 women (%50.3) with cancer were were studied. Age 65 and older had the most emergency visits. The most common reason for patients to visit was: pain in different organs (18.2%), fever (8.7%), weakness and malaise (7.5%). A total of 617 (55.7%) visits were potentially preventable. Age 17 years and younger (OR, 3.172; 95% (CI), 2.409-4.021) and presence of more than 1 comorbidity (OR, 3.610; 95% (CI), 3.611-4.521) were positively associated with potentially preventable visits.
Conclusion: In this study, 50.7% of ED visits among patients with cancer were identified as potentially preventable, and the most common reason for patient visits was general and non-specific symptoms such as pain, weakness, and malaise. These findings highlight the need for palliative care and evidence-based interventions in outpatient settings.

The prevalence of trichomonas vaginalis in iranian women: a systematic review and meta-analysis
Mahsa Hojjati, Mahshid Rashidi, Ali Asghar Khaleghi, Maryam Nasirian, Seyed Hassan Faghihi, Masoud Mohammadi,
Volume 83, Issue 3 (6-2025)
Abstract
Background: Trichomonas vaginalis is one of the main causes of vaginitis and cervical inflammation worldwide. Almost half of sexually transmitted and curable diseases worldwide can be assessed through the examination of this disease, so the aim of this study is to determine the prevalence of trichomoniasis in Iranian women.
Methods: This study is a review of the SID, PubMed, Science Direct, and Google Scholar databases, conducted up to September 2023. The extracted data were analyzed using CMA software (version 2). A search of articles in Science Direct, SID, PubMed, and Google Scholar databases was conducted in accordance with the PRISMA statement criteria, including systematic search, screening of articles, and selection of appropriate studies. The words used for the search and final review in this systematic review were determined based on MESH Terms in the PubMed database. These keywords that were used and selected in this study were in English and Persian. The final information obtained from the studies was reviewed and analyzed using the Comprehensive Meta-analysis (CMA, Version 2) software, and finally the heterogeneity of the studies was examined with the I2 test.
Results:  Based on the search for studies and their screening, 22 studies were finally included in the meta-analysis. This study included a sample size of 49,990 Iranian women who were included in the study. In the heterogeneity analysis based on the studies obtained, the heterogeneity was 99.7. Due to the heterogeneity of the studies, the random effects method was used for the final analysis. The prevalence of Trichomonas vaginalis in Iranian women was reported to be 9.3 (95% CI: 4.6-18) based on the 22 final studies and meta-analysis. The publication bias analysis indicated the absence of bias in the studies (p: 0.175).
Conclusion:  Based on the prevalence report in the meta-analysis, a relatively high prevalence was reported in Iranian women, and this situation requires more awareness raising through health centers to families, as well as care and screening of women in these centers and also in obstetric centers.
 
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